Treat-and-Release Emergency Department Use by Patients With Gynecologic Cancers

Key Points

The number of treat-and-release emergency department visits and total cost of visits increased markedly between 2009 and 2013.

The cost per visit has not increased markedly.

In a study reported in the Journal of Oncology Practice, Albright et al found that treat-and-release emergency department use by patients with gynecologic cancers has increased in recent years, with an increase in total cost in this population but not in average visit cost.

Visits and Costs

Patients with gynecologic cancer diagnoses who were treated and released from 2009 to 2013 were identified from the Nationwide Emergency Department Sample, a stratified sample of U.S. hospital–based emergency department visits. During this time, there were an estimated 174,092 annual treat-and-release emergency department visits by patients with gynecologic cancer, corresponding to $736 million in annual charges and an average visit charge of $4,232.

The total number of visits increased from 142,930 visits in 2009 to > 200,000 visits in 2013; total costs increased from $559 million to $940 million over this time. The mean cost per visit increased from $3,912 in 2009 to $4,650 in 2013. Medicare and Medicaid represented the primary payer for 58.7% of the total charges over the study period, with the percentage of visits by Medicare patients increasing from 32% to 37%.

Additional Findings

For the entire study period, patients with cervical cancer (44.1%) accounted for more treat-and-release visits than those with ovarian cancer (27.8%) or uterine cancer (24.6%). These patients were younger and more likely to be from low socioeconomic status areas. The most common primary diagnoses for the emergency department visits were similar across cancers, including abdominal pain (10.5%), chest pain (6.1%), and urinary tract infection (5.2%).

The most frequent diagnostics used were culture/smear, computed tomography scan, and x-ray. The most frequent therapeutic procedures included wound care, transfusion, and paracentesis.

The investigators concluded, “Patients with gynecologic cancers—and cervical cancer in particular—are frequently seen in the emergency department with issues that could be less expensively managed in an outpatient clinic or urgent care setting. Visit frequency, but not per-visit cost, is increasing over time.”